Impaired attention function based on the Montréal Cognitive Assessment in vascular dementia patients with frontal hypoperfusion: The Osaki-Tajiri project.

We previously reported that the Montréal Cognitive Assessment (MoCA) was effective in the evaluation of cerebrovascular diseases. We also demonstrated that the test was effective for screening for very mild vascular dementia (VaD) in the community. Herein, we examined the effectiveness of MoCA in the assessment of patients with VaD in an outpatient clinic. Forty-four patients with VaD (National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences [NINDS-AIREN] criteria) and 58 patients with Alzheimer's disease (AD) (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association [NINCDS-ADRDA] criteria) were compared with 67 non-demented control subjects. All were outpatients at the Tajiri Memory Clinic, Osaki-Tajiri, northern Japan. All underwent 1.5 Tesla MRI and ethyl cysteinate dimer (ECD) single photon emission computed tomography (SPECT) examinations. The SPECT images were used to classify the VaD patients into two subgroups, those with frontal hypoperfusion (F-VaD) and those without frontal hypoperfusion. The frontal hypoperfusion pattern was defined as the "P2" pattern of the Sliverman classification, with or without focal hypometabolism in other areas, based on the agreement of three neurologists who were blinded to the results of the neuropsychological examinations. Total scores and attention subscores on the MoCA were lower in the F-VaD group compared with other groups. Our results suggest that the MoCA attention subscale can detect VaD participants, particularly those with frontal hypoperfusion.

[A case of obstruction in the left internal jugular vein which both ultrasound prescan and chest computed tomography could not detect before the insertion of a pulmonary artery catheter].

In a 54-year-old man, at the time of anesthesia administration during the Bentall re-operation, a preoperative ultrasound scan showed right internal jugular vein thrombosis before insertion of a pulmonary artery catheter into the right internal jugular vein. Therefore, we performed the insertion after confirming that the left internal jugular vein was safe via a preoperative ultrasound and chest computed tomography (CT). Although we could insert the catheter sheath, contrast imaging revealed that the pulmonary artery catheter had advanced no further than approximately 15 cm into the left internal jugular vein. Similar advancement was noted when inserting the pulmonary artery catheter under fluroscopic guidance. This indicated an obstruction in the confluence of the left internal jugular vein and the brachiocephalic vein. A postoperative chest contrast CT showed thrombosis in the confluence of the left internal jugular vein and the brachiocephalic vein. Considering that the chest CT scan was performed 2 months before the surgery, it is necessary to perform imaging again before surgery.